0岁-2岁婴幼儿家庭育儿能力的研究进展

了解0岁-2岁婴幼儿家庭育儿情况,为制定相应干预措施和提高广大父母育儿技能提供依据,并有针对性地改进儿童保健工作,促进儿童早期全面发展。     

宁波市0岁～3岁儿童早期综合发展模式调查研究

[目的]了解宁波市部分社区0岁～3岁儿童早期综合发展模式的现状,为改进0岁～3岁儿童早期综合发展服务体系提供对策与措施.[方法]采用二阶段随机整群抽样方法,以宁波市3个社区内1 050名0岁～3岁儿童为对象,采用自行设计的"0岁～3岁儿童早期发展模式基本情况调查问卷"进行调查.[结果]62.8%的0岁～3岁社区儿童由家长(父母或祖辈)看护,而家长的素质并不能满足0岁～3岁儿童综合发展的需要且家长获得育儿知识的途径较为单一;4.7%的0岁～3岁社区儿童由社区服务机构看护,而社区服务机构人员的素质也不能完全满足0岁～3岁儿童综合发展服务的需要以及家长的期待与要求.[结论]加强对0岁～3岁儿童家长的育儿指导与培训,同时强化政府职责,完善、规范社区服务机构队伍人员的准入标准.     

沧州市3～6岁儿童体格发育现状调查

目的 了解沧州市区3～6岁儿童体格发育现状.方法 采用分层随机整群抽样的方法对沧州市3所幼儿园3～6岁1 100名儿童进行体格发育调查.结果 2010年沧州市3～6岁儿童各年龄组体重、身高男童好于女童(P＜0.01),生长发育水平高于2005年全国九市标准(P＜0.01).结论 沧州市3～6岁儿童体格发育总体良好;普及科学育儿知识、防治儿童营养过剩是今后儿童保健的重要内容.     

1 172名0～6岁儿童血铅水平流行病学调查分析

【目的】了解长沙市0～6岁儿童血铅水平、铅中毒现状以及血铅水平的影响因素。【方法】整群分层随机抽样调查2个城区0～6岁儿童1172例,其中男672例,女500例。采用BH2100微量血测铅仪测定末梢血中血铅水平。选用“中国部分城市儿童铅中毒防治项目调查表”进行问卷调查。【结果】儿童的喂养方式、生活习惯、卫生习惯、户外活动时间、钙、锌、铁剂的使用是儿童血铅水平的影响因素。【结论】儿童随着年龄增长铅中毒检出率增加。采用科学的喂养育儿方式,培养儿童良好的生活卫生习惯有利于预防和减少儿童铅中毒。应重视儿童铅中毒的防治。     

略谈三岁前婴幼儿的教育

目前,我国儿童多是独生子女。国家要求把新一代培养成体魄健壮、智力发达、品德良好的接班人。在这方面,儿童保健工作者负有经常指导托幼机构工作,向家长宣传科学育儿知识的责任。因此,从事儿童保健工作的医护人员,不能仅限于进行一般的医疗保健措施,     

湖南省5岁、12岁人群口腔健康行为抽样调查报告

【目的】了解湖南省5岁、12岁人群口腔健康知识、行为,为湖南省制订今后口腔卫生政策提供依据。【方法】采用多阶段分层等容量随机抽样的方法,抽取湖南省5岁城乡常住人口共349人,其中城市168人,农村181人;抽取12岁城乡常住人口共360人,其中城市179人,乡村181人。按照《第三次全国口腔健康流行病学问卷调查方案》设计的5岁、12岁口腔健康调查问卷,由问卷调查员面对面进行问卷调查。【结果】5岁儿童中刷牙频率为每天1次以上的为84．7％,78．0％的儿童从未看过牙医。12岁儿童中刷牙频率为每天1次以上的为87．5％,47．8％的儿童从未看过牙医,43．8％的12岁儿童听说过含氟牙膏,但知道含氟牙膏对牙齿有好处的只有15．9％。与居住在农村的儿童相比,城市儿童口腔保健行为更积极,知识更丰富。【结论】应采用不同方式的口腔健康教育,去促进儿童尤其是农村儿童建立正确的口腔健康行为。     

南宁市江南区3岁～4岁儿童龋病调查

[目的]了解社区3岁~4岁儿童龋病患病情况,为今后探讨行之有效的儿童防龋护理干预提供依据。[方法]随机抽取南宁市江南区7所幼儿园3岁~4岁儿童588名作为调查对象,进行龋病患病情况及其相关因素的调查。[结果]龋病发生率51.19%,平均4.85颗;不同生活习惯及家长口腔保健意识与儿童龋病发生率有关(P<0.001)。[结论]波浪式刷牙、食后漱口、不常吃零食及甜食、家长的经常监督检查是预防龋病的有效方式。     

0岁～3岁儿童二类疫苗接种影响因素的研究进展

综述0岁~3岁儿童二类疫苗接种影响因素的研究进展。主要内容包括二类疫苗的分类、接种的不良反应、0岁~3岁儿童二类疫苗接种现状以及接种影响因素、提高二类疫苗接种率的对策和对今后研究的启示。发现受家庭、儿童、疫苗和社区工作因素的影响,我国的二类疫苗接种率仍旧偏低。为提高接种率,可采取定期对社区预防接种工作人员进行考试、加大地方宣传力度和制订符合国情的外地户籍儿童疫苗接种计划等措施,且可进一步研究针对流动儿童的相关接种流程以及如何提高儿童家长的认知水平。     

泰兴市5岁以下儿童意外死亡分析

目的：了解泰兴市0～4岁儿童意外死亡的现状,降低泰兴市0～4岁儿童意外死亡率,提高儿童健康水平。方法：分析2003年－2007年0～4岁儿童意外死亡类别及分布情况。结果：0～4岁儿童意外死亡率有上升趋势,意外死亡为0～4岁儿童死亡的第一位原因,占总死亡数的30．840％。意外死亡原因主要为：溺水、意外窒息、交通意外。婴儿期主要意外死因为意外窒息,1～4岁儿童主要意外死因为溺水及交通意外,意外窒息、溺水、交通意外有季节性特点。结论：意外伤害已成为0～4岁儿童死亡的主要原因,要通过针对儿童的宣传干预,提高家长对儿童安全的防范意识,最大限度地降低儿童意外死亡率,提高儿童生存水平,从而降低0～4岁儿童死亡率。     

我国11城市3～6岁儿童单纯肥胖症危险因素分析

目的 探索我国城市3 ～6 岁儿童生活方式和饮食习惯与肥胖的关系,为制订儿童肥胖干预策略提供依据.方法 采用分层整群抽样,分别从成都、济南、深圳、沈阳、上海、重庆、郑州、西安、长沙、青岛和海口11 个城市中随机抽取3 个城区,每个城区随机抽取幼儿园6 所,所有在园儿童进行体格测量,以WHO 的身高标准体重加2 个标准差作为肥胖判断标准.将调查中确诊的单纯肥胖症儿童与同性别、同年龄、同班级的正常体重儿童进行1∶2配对后,对所有肥胖儿童和配对的正常体重儿童进行家长自填问卷调查,回收的完整调查问卷中2218 份肥胖问卷和5380 份正常体重问卷,分别作为本研究的肥胖组和对照组.结果 单因素和多因素Logistic 回归分析结果显示,高出生体重(OR ＝1.48)、母亲受教育程度低(OR ＝1.20)、父母超重(OR ＝1.55、OR ＝1.81)、每周食用甜饮料≥3 次(OR ＝1.34)、食欲好(OR ＝4.07)、进食速度快(OR ＝2.77)、4 个月前非纯母乳喂养(OR ＝1.71)为儿童肥胖发生的危险因素;分别有45.6%和84.9%的肥胖儿童家长对儿童体型和肥胖对健康危害的认识做出不正确的评价和存在错误认识;分别有53.4%、43.3%和51.2%的肥胖儿童家长有鼓励进食、食物奖励和不限制零食的行为.结论 3 ～6 岁儿童肥胖的发生与家庭养育环境密切相关,喂养方式、饮食习惯和错误的育儿观念是儿童肥胖发生的主要危险因素.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.